Medicare Corrects Bilateral Status

on Wednesday, 05 June 2013. All News Items | Billing

In the July 2013 Update to the 2013 Medicare Physician Fee Schedule (MLN MM8291), Medicare corrected the bilateral indicators for three CPT codes: 37211, 37212, and 92071. These codes were originally assigned to a bilateral indicator of “0” which means laterality is not recognized. The codes now have a bilateral indicator of “1”; a 150% payment adjustment applies when these codes are billed with modifier 50. The change is effective from January 1, 2013, but the implementation date of the transmittal is not until July 1, 2013.

 

Note this instruction from the February 2013 CPT Assistant concerning CPT codes 37211 and 37212: “Modifier 50 is appended to codes 37211 and 37212 for bilateral thrombolytic infusion through a separate access site(s) (e.g., bilateral lower extremity deep venous thrombosis). Modifier 59 is appended to codes 37211 and 37212 when thrombolytic infusion is performed in two completely separate vascular beds (e.g., cardiac embolization to a renal artery and a femoral artery).”

 

Since Medicare contractors will likely not be able to correctly process the bilateral payment change until July, providers may wish to hold claims that include these codes billed bilaterally until July. If claims are processed incorrectly prior to July, providers may wish to appeal.

 

Article by Debbie Rubio

Debbie Rubio, BS, MT (ASCP), is the Manager of Regulatory Affairs and Compliance at Medical Management Plus, Inc. Debbie has over twenty-seven years of experience in healthcare including nine years as the Clinical Compliance Coordinator at a large multi-facility health system. In her current position, Debbie monitors, interprets and communicates current and upcoming regulatory and compliance issues as they relate to specific entities concerning Medicare and other payers. You may contact Debbie at  This email address is being protected from spambots. You need JavaScript enabled to view it. .

 

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